Policy Changes for Payment of Evaluation and Management Services

Effective September 1, 2024, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will begin reimbursing evaluation and management services at fifty percent (50%) when performed by the same provider/group practice on the same day as a minor procedure. The updated policy was posted on May 1, 2024 here.

This policy update applies to Commercial, Host, State Health Plan (SHP), Federal Employee Program (FEP) and Medicare Advantage. This policy update does not apply to Inter-Plan Programs (IPP) Home.

In addition, the following applies only to Medicare Advantage:

Effective July 10, 2024, Blue Cross NC will begin reimbursing evaluation and management services at fifty percent (50%) when performed on the same day as an annual wellness or preventative exam. Preventative exams will also be reimbursed at fifty percent (50%) when performed on the same day as an annual wellness visit. The updated policy was posted on May 1, 2024 here.

These reductions in reimbursement are due to duplicate and overlapping professional practice expenses, such as: scheduling of appointments, use of exam room and equipment, and obtaining vital signs.

Additional information regarding reimbursement for annual wellness visits and preventive exams for our Medicare Advantage products can be found here.